The Force Failed Me

A caregiver brings in a somewhat demented patient in his 60s for evaluation of abdominal pain. The patient does have dementia, but he knows what’s going on around him.

Interesting scenario because over the past several months, the patient has regularly been admitted for abdominal pain workups on a Friday morning and discharged on a Monday or Tuesday. Just an odd pattern of the patient always needing to be admitted on Fridays. Then again, with the patient admitted to the hospital, the caregiver had nothing to do over the weekends. Wink wink.

This visit the patient was fine. He was better than fine. I could poke on his stomach without him even wincing.
“See, no pain, doc,” he told me. “I haven’t had any pain today. I just want to go home.”
The nurses had already given him a sandwich and a cup of juice.
He was happy. Labs and urine were normal. Previous workups in the computer showed nothing abnormal. I was happy. Cool. You’re on your way home.

Then an air of evil came over the room. The caregiver suddenly appeared through the door.

“I’ll be sending him home soon,” I told her.
“But what about his pain?” She asked.
“He’s not having it any more,” I replied with a smile on my face. “Said he hasn’t had it all day.”
“He has the pain, but he just doesn’t know how to say so.” She waved her hand in the air and said “You’re having pain, right Obi-Wan?”
“I’m having pain in my stomach, yeah.” He parroted.

So I wave my hand and say “But the pain is gone now, right, Obi-Wan?”
“Yeah, the pain is gone now.”
“In fact, you haven’t had the pain all day and you want to go home, don’t you?”
“Yeah, I just want to go home.”

I raised my eyebrow. Darth Maul scowled.

She waved her hand again. “Yes but you always get vomiting after your abdominal pain and you get dehydrated very easily once you start to vomit, right Obi-Wan?”
“I do get dehydrated really easy when I start vomiting,” he said. I could hear the buzz of a light saber being activated behind Darth Maul’s back.
“But you don’t feel sick now and you’ve already had a drink of apple juice and a sandwich, right Obi-Wan?”
“That’s right, I already ate and I don’t feel sick.”
“Besides, I can give you medicine to take at home if you get nauseous.”
“That’s true, I can take medicine at home,” Obi-Wan said.
Darth Maul’s eyes glowed red.
This could go on forever.
She waved her hand and started to say “But you’re …”
I cut her off. “I’ll get your discharge papers together in a minute, then. Glad you’re doing so much better.”
“Me, too. I’m glad I am doing so much better.”

As I was entering the discharge instructions in the computer, there was a serious rift in the force. A chill swept through the department as a dark figure walked by, black cape flittering behind him. He stopped at the patient’s room, gave an Imperial Stormtrooper salute to Darth Maul, grabbed the patient’s chart and wrote admitting orders on the patient without even doing an exam. Then he strode out while the Imperial March played somewhere in the distance (you have to click the link to get the true effect).

Darth Maul must have summoned him with her handheld communicator. Dammit, why don’t they ban those things from the emergency department?

You win this round, evil one. Next time I’m going to lop off your hand with my light saber and stomp on your communicator before it transmits your distress signal.

I needed backup. And just where the hell is Yoda when you need him, anyway?
Probably off at that Tatooine bar making out with that three-headed hottie from Bestine.
He always had a thing for her.

At any rate those are my favorites, especially the 3-day weekend dumps, or the Death Star of them all, the Holiday Scramble, where the nursing homes empty onto the wards as “Grandma doesn’t look so god…”

Great post. It’s sort of scary, though, when you think of the power that home health caregivers have. Where is the quality control? In the future, this will become a greater issue when there are even more home health caregivers taking care of millions of demented, old baby boomers.

I could make a stink that I think the patient is being inappropriately admitted, but then my relationship with the attendings becomes adversarial. I don’t want that.
Most people argue that there are differences in medical judgment. I’m sure they complain on their blogs because I discharge some patients they believe should be admitted.

my ceo’s mother who has Altzheimer’s and lives with her always develops “mental status” changes right before she goes on vacation…go figure. Too cheap to hire a sitter?..oh that’s right bill it to medicare.

I used to work as a home health care giver and I would never have done something like that to the people I helped — no matter how annoying they could be. That’s disgusting. Great post though, I love the Star Wars analogy.